Biotin Deficiency in a Patient with Short Bowel Syndrome during Home Parenteral Nutrition

Abstract

A 54-year-old woman with short bowel syndrome was supported with home parenteral nutrition. Six months after receiving 2200 kcal/day of balanced home parenteral nutrition without biotin, she developed biotin deficiency with complete hair loss, eczematous dermatitis, waxy pallor, lethargy, and hypersthesias. Blood and urine samples were collected prior to treatment. Serum zinc was 64 μg/dl (nl 50-150 μg/dl), and the triene/tetraene ratio was 0.068 (nl 0.4), thereby ruling out zinc and essential fatty acid deficiencies. Serum biotin was 332 pg/ml (nl 520 ± 220 pg/ml), and urine biotin was 5.22 ng/mg of creatinine (nl 4.3-95 with a mean of 30.2 ng/mg creatinine). The same parenteral nutrition regimen was contained and oral biotin was administered (10 mg/day). After 3 wk, serum and urine biotin levels were 650 pg/ml and 35.6 ng/mg creatinine, respectively. New hair growth was evident and all of her other symptoms resolved. Intravenous biotin was then provided (5 mg/day) for a month after which serum and urine biotin levels were 1316 pg/ml and 178 ng/mg creatinine, respectively. The patient has been subsequently maintained on an intravenous multivitamin product containing 60 μg biotin per daily dose and remains free of signs and symptoms of biotin deficiency. (Journal of Parenteral and Enteral Nutrition 8:311-314, 1984)